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    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
      • Personality Disorders -- Unscientific & Vague -- Must Be Reformed
    • Executive Functioning & "Prison Brain" >
      • Job Accommodation Network on Executive Functioning Deficits
    • Medicaid & Medicare Network Adequacy >
      • OIG: STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE (Sept. 2014)
      • OIG: ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE (Dec. 2014)
      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
      • CMS: Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability (April 2017)
    • Medicaid Mental Health & Substance Use Disorder Parity >
      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
      • Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. (2011)
      • Comprehensive Olmstead Planning
      • the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment
      • Olmstead Nation ---State Pages: How Far to Comply with Olmstead?
  • Take A Walk Around Orchid's Resource Block
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  • Double V
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  • VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION
  • Updating & Reforming our Understanding & Treatment of "Anti-Social Personality Disorder" Blog
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  • Microglia and the Brain's Immune System
  • Substance Issues & the Immune System

Olmstead, Neuro-Developmental Differences & Psychiatric Disorders  Cognitive / Remediation & Work-Arounds to Address Executive Functioning

10/20/2022

 
Conjecture
  • When we think about who is INSTITUTIONALIZED or AT RISK OF INSTITUTIONALIZATION we might think of that person who:
    • Has a Developmental Disability & an IQ below 70.
    • Has a Psychiatric Disorder, or
    • Has a Brain Injury
 
  • The reality is a lot of people with a Psychiatric Disorder or a Brain Injury are also people who started out with a Neuro-Developmental Difference with an IQ above 70.
 
  • This is implicating so many "IDEAS" we have in our SOCIETY that are NOT AS CONNECTED TO REALITY as they might be.
 
  • A lot of this is not understanding how connected "TRADITIONAL INTELLIGENCE" is with SENSORY PROCESSING.
 
  • Surprisingly, people with Neuro-Developmental Differences and Psychiatric Disorders have HYPER-CONNECTED BRAINS.

  • One of the IRONIES of having a HYPER-CONNECTED BRAIN is that EMOTIONAL REGULATION is CHALLENGING ---
    • You're spending a lot of time on that because THINGS ARE HITTING ALL AT ONCE.
PARSING OUR APPROACH to "MENTAL HEALTH"
  • Right now Mental Health has typically meant Talk Therapy and Medication.
    • There's a role for those
  • What seems to be emerging is the need to address EXECUTIVE FUNCTIONING as much more THE MAIN COURSE.
  • Further, when we think about Olmstead & the Integration Mandate ---- addressing Executive Functioning --
    • is probably one of the KEYS for both people with Neuro-Developmental Differences & Psychiatric Disorders
    • On the other hand, it won't be enough if we don't develop and employ those BIG STRENGTHS that also come from HYPER-CONNECTED BRAINS.

At least in 2022, this needs to be a Hybrid Approach with:
  • Occupational Therapy, Cognitive Remediation Therapy and/or Coaching, etc. on the one hand, and
  • Work-Arounds and Accommodations on the other hand.
By and large, I don't think the current diagnostic categories are FUNDAMENTAL insofar as:
  • Most disorders share common genes
  • Many to most people with a Neuro-Developmental/Psychiatric Disorder have MULTIPLE DIAGNOSES
    • The University of Colorado has recognized this is NOT HELPFUL.

Recognizing the role of MATERNAL IMMUNE ACTIVATION in many cases and the IDIOSYNCRATIC NATURE OF THAT on SHARED GENES --- I think helps to explain the wide variety in the population.

To me, it's about SHARED GENES and at least in many cases MATERNAL IMMUNE ACTIVATION --- and the current diagnostic categories are falling apart.

DRAFT:  Occupational Therapy, Cognitive Remediation Therapy & Coaching to address Executive Functioning in Neuro-Developmental & Psychiatric Disorders
In this video, Florence Welch isn't "FREE" in the way we want to believe.

The FEELINGS are HITTING ALL AT ONCE --- A HUNDRED TIMES A DAY.  Further, this video shows the FATIGUE of NEURO-DIVERSITY like nothing I've ever seen before.

Welch has Dyslexia and Dyspraxia and has spoken about Addiction and Severe Depression.


Environmental Mutagenesis and Genomics Society (2020)

Grandmaternal Smoking & Risk for ADHD

Gyeyoon Yim, PhD student, Harvard University Speaking on Heritable Hazards of Smoking

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Messy, Messy Chic
The Radical History of Women Smoking

History, Neuro-Diversity AND INFLAMMATION
  • I don't think that Neuro-Diversity is that new -- but I think the PROXIMATE CAUSES can change, especially since INFLAMMATION seems to be such a UNIVERSAL LANGUAGE -- coding for a WIDE VARIETY OF THINGS.
  • So I think Maternal & Grandmaternal Smoking during the 20th Century are BIG DRIVERS of the Neuro-Diversity Explosion we're seeing in the 21st Century.
  • That's probably not true historically.
  • What I'm trying say is that I think we have HUGE GENERATIONAL, BIOLOGICAL CHALLENGES with regard to NEURO-DIVERSITY in this SOCIETY.
  • Further, those CHALLENGES are BIOLOGICAL but they are weirdly SOCIAL in that our IMMUNE SYSTEMS control social behavior and being at the bottom of the Social Heap damages the immune system.
  • We are ahead of ANCIENT ROME and their CRAZY EMPERORS --- but we're not as far along as we think ---
    • Whether it's Clinton, Trump or Putin.
    • Or a Legal Profession & a Judicial Bench full of "emotionally intense gifted/asynchronous people" or a modern Mental Health Profession that's not on the top of the research but is happy to testify in CRIMINAL COURT and do their pro-socially competent duty.
 We're being called on to handle "MORE REALITY" than what we've been doing --- and that literally isn't easy --- it takes time and energy to do.

3 Olmstead Complaints:  Georgia, New York & Mississippi

10/13/2022

 
3 Olmstead Complaints that include a Request for Declaratory Judgment against:
  • Georgia
  • New York, and
  • Mississippi
 
  • Upper Right:  Factual Allegations from each of the 3 complaints.
 
  • Below Right:  single document with the "Prayers for Relief."
Factual Allegations
Prayers for Relief

Part I:  Threading the NEEDLE and "Dangerous Binaries" When it comes to People with  Serious Mental Illness and Fair Housing

10/12/2022

 
*DOJ --if you're gonna enforce Olmstead uniformly & across the board and obtain SUPPORTIVE HOUSING for People with SMI in this Country --- great --- If not, what are ya thinkin'?  --- Residents & Families United to Save Our Adult Homes, et al. v. Zucker
In some instances we have tried to "BACKDOOR" Community Living for people with SMI (Serious Mental Illness) with:


  • Medicaid’s Institutions for Mental Diseases (IMD) Exclusion Rule ...

"The IMD exclusion rule, which has been in place since the beginning of the Medicaid program in 1965, bars the use of federal Medicaid funds to finance services for individuals ages 22 to 64 residing in “institutions for mental diseases” or IMDs—hospitals, nursing homes, or other institutions with more than 16 beds that are primarily engaged in providing diagnosis, treatment, or care of persons with “mental diseases” other than dementia or intellectual disabilities."

So we actually have the LAWS now to REQUIRE STATES to Avoid the Unnecessary Institutionalization or Risk of Institutionalization of People with Disabilities.

We didn't have those LAWS when
De-Institutionalization was first becoming a big thing in the 1950s.
  • Deinstitutionalization: Definition & History | Study.com

BUT our thinking on this has "EVOLVED" quite a lot.  The miracle of Psychotropic Drugs for some people led us not to build the INFRASTRUCTURE we needed to successfully integrate people with SMI in the Community.

I do think DOJ has a pretty good handle on what that SMI COMMUNITY LIVING INFRASTRUCTURE is or needs to be---
  • DOJ does NOT have a good handle on enforcing that SMI COMMUNITY LIVING INFRASTRUCTURE across the STATES uniformly to prevent INCARCERATION and HOMELESSNESS of people with SMI and other Cognitive Disabilities.

THIS FAILURE OF ENFORCEMENT or POLITICS or whatever to provide that SMI COMMUNITY LIVING INFRASTRUCTURE ---- HAS ENORMOUS CONSEQUENCES --- namely, the MENTAL HEALTH CRISIS we're currently in ---
  • And a lot of INCARCERATION and HOMELESSNESS of people with SMI and other Cognitive Disabilities
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Image Credit:  PaulClairereaux.com
*Residents and Families United to Save Our Adult Homes, et al. v. Zucker
"On May 31, 2022, the United States filed a Statement of Interest in the consolidated case of Residents and Families/Empire v. Zucker. Residents and Families/Empire challenges a New York State regulation limiting admission of individuals with Serious Mental Illness (SMI) into segregated settings called Adult Homes, by alleging that the regulation violates the Fair Housing Act and the Americans with Disabilities Act.  

"The State issued the regulation in conjunction with the United States’ settlement in U.S. v. New York, No. 13-cv-4165 (E.D.N.Y. 2013) and consistent with its Office of Mental Health’s determination that Adult Homes “are not clinically appropriate settings” for individuals with SMI, “nor are they conducive to the rehabilitation or recovery of such persons.”  The Statement of Interest explains that the regulation does not violate the Fair Housing Act or the Americans with Disabilities Act. (5/31/22)"
Why Is This Problematic?

Advocates & Attorneys around the country like myself want to use Fair Housing and the ADA to get people with SMI a safe place to live.

Further, those people want a safe place to live.

Horror Stories
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So if we don't UNDERSTAND --- THE REALITIES ON THE GROUND --- namely many people with SMI are trying to navigate a MINEFIELD in which  ---"ADULT HOMES" or even "NURSING HOMES" are not the "BEST" OPTIONS and they may not even be "GOOD" options--BUT the HORRIFIC OPTIONS that we thought our Society was TOO HUMANE TO ALLOW --- Is ALLOWING THEM. 
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Vox:  Jails, prisons hold 10 times more mental health patients than state hospitals (2014)

NOT SO RANDOM THOUGHTS

10/11/2022

 

The History of Ideas Discussion Meetup based out of Cork, Ireland has a WAITLIST for Candide or Optimism

Could we get a WAITLIST for Assertive Community Treatment in Colorado Medicaid?
and
A WAITLIST for HOUSING out of the Colorado Division of Housing for people with disabilities who are institutionalizated or at risk of institutionalition?
and
BOTH WAITLISTS moving at a "REASONABLE PACE" -- ?

This isn't just "IDEALISTIC" ---- THEORETICALLY, if we bothered to comply with FEDERAL LAW --- this would already be done.

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Fair Housing, the Co Dept. of Law, Disability Housing & Olmstead

10/10/2022

 
Lack of Disability Housing both Accessible Housing & Supportive Housing is a MAJOR FAILURE of Colorado Policy and Compliance with Federal Law.

Olmstead provides that if States want a DEFENSE to not having DISABILITY HOUSING to SCALE (as well as other things) ---
  • Then States need a COMPREHENSIVE, EFFECTIVELY WORKING PLAN ---- and WAITLISTS moving at a "REASONABLE PACE."

In 1999, the US Supreme Court in Olmstead was really talking about waitlists of PEOPLE --- moving out of institutions.

BUT that is HARD TO DO if you don't DRILL DOWN a little further and understand what SERVICES, HOUSING, PLACEMENTS, etc. that you need to move people out of institutions.

Further, ACCESSIBLE HOUSING for people with "physical disabilities" has been CLEARER even though we haven't provided enough.

I'm not sure that SUPPORTIVE HOUSING was the buzz word in 1999 that is today --- but it is pretty clear in 2022 that SUPPORTIVE HOUSING is a BIG PIECE of the Puzzle for people with "cognitive disabilities."

I'm using "cognitive disability" in a BROAD SENSE of PSYCHIATRIC DISABILITY, DEVELOPMENTAL DISABILITY, BRAIN INJURY and SUBSTANCE ISSUES.

Further, these issues are often overlapping or CO-OCCURRING.

The Colorado Dept. of Law's Fair Housing Unit is to be focused on STATE LAW --- but I'm not sure with respect to "DISABILITY" that is hugely different from Federal Law.

Bringing in the CO Dept. of Law's Fair Housing Unit as well as CO Dept. of Regulatory Agencies as OFFICIAL STAKEHOLDERS in a CO OLMSTEAD PLANNING PROCESS could help to RAISE THE STATUS of the DISABILITY HOUSING ISSUE.

Finally, in the words of the US DEPT. OF JUSTICE:
  • Measurable Goals
  • Reasonable Time Frames, &
  • Funding to Support the Plan
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HB22-1082

Establish Fair Housing Unit Department Of Law

Concerning the enforcement of state housing laws by the department of law, and, in connection therewith, establishing a fair housing unit within the department of law.

Below via CO Department of Regulatory Agencies --
Civil Rights Division

Protected Classes Enumerated at C.R.S. § 24-34-502

  • Disability (a mental or physical impairment which substantially limits a major life activity)

    • Race
  • Creed
  • Color
  • Religion
  • Sex
  • Sexual Orientation (which is statutorily defined as "including transgender status" - i.e. Gender Identity)
  • Martial Status
  • Familial Status 
  • National Origin
  • Ancestry
  • Source of Income*
Persons who have engaged in protected activity (such as making a complaint of discrimination, or requesting a reasonable accommodation) are protected from retaliation for doing so. 


* Source of Income as a protected class effective January 1, 2021, see HB20-1332
See Also:
Fixing HCPF's FAIR HOUSING PROBLEM

OLMSTEAD & INCARCERATED & CHRONICALLY HOMELESS PEOPLE WITH COGNITIVE DISABILITIES

10/6/2022

 
Conjecture
  • Let's just say that all things being equal (and they're not) there are people in both major political parties at the top of this society with Behavioral Challenges that with any "justice" would be INCARCERATED -- and they're not.
    • & I'm not even for incarceration.
 
  • I think it is clear that people with cognitive challenges can live in the COMMUNITY WITH SUPPORT.
 
  • The CHALLENGE for our Society is getting beyond a BLANK CHECK for a few at the top and addressing SERIOUS COGNITIVE DISABILITY in this SOCIETY in an ECONOMICALLY & MORALLY Responsible Manner ---
    • Part of that would be complying with Olmstead.
 
  • The late D.J. Jaffe of the Mental Illness Policy Organization was fond of taking government and the mental health industry to task for focusing on "THE WORRIED WELL" and not the people with the most serious challenges.

Olmstead makes a PRIORITY of those people with disabilities that are INSTITUTIONALIZED or AT RISK of INSTITUTIONALIZATION.
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Addressing Assertive Community Treatment in the 2023 CO Legislative Session

10/4/2022

 
Indiana's Criteria for Assertive Community Treatment & Recognizing ACT as an Olmstead, Parity & Human Rights Issue
2022 Indiana Administrative Code: Assertive Community Treatment Teams
2021 Minnesota Statutes: 256B.0622 ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL TREATMENT SERVICES.
Minnesota Department of Human Services: Assertive Community Treatment Policies & Procedures
Assertive Community Treatment is used globally to provide Intensive Community Mental Health Treatment and to provide an alternative to the Criminal Justice System --- see Eppa Worldwide 
This is a beautifully made video on Housing First and Assertive Community Treatment from British Columbia, Canada from 2014.

I've posted it many places on the website because it does have so many gems.

Most countries are in the situation of the US --- trying to figure out how to bring ACT to SCALE.

In the US, that's probably state statutes addressing the issue.

Draft Addressing Assertive Community Treatment for the 2023 CO Legislative Session

The Integration Mandate, confusing combinations & Employment

9/28/2022

 
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Conjecture
  • The US Supreme Court based its holding in "Olmstead" on the INTEGRATION MANDATE of the Americans with Disabilities Act.
  • In 1999, the Supreme Court held that "UNNECESSARY INSTITUTIONALIZATION" of people with disabilities violated Title II of the ADA -- specifically the "INTEGRATION MANDATE."
 
  • When we're thinking about "INTEGRATION" and Olmstead and especially COGNITIVE DISABILITY ---
    • We're thinking about INTEGRATION OF PEOPLE --- and
    • INTEGRATION OF KNOWLEDGE across DISCIPLINES and the SOCIETY.
 
  • For people with "PHYSICAL DISABILITIES," the INTEGRATION OF KNOWLEDGE has included
    • Construction of curb cuts and ramps
    • Hearing Devices
    • Speech Aid Devices
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One of the things that has been so CONFUSING and DIFFICULT for Neuro-Diversity and Psychiatric Disorders ----
  • People can be "ASYNCHRONOUS" in ways we're not expecting --
  • They might have INTELLECTUAL, CREATIVE and/or ATHLETIC GIFTS and ---
    • Nonetheless, struggle with Executive Functioning issues such as:
      • Working Memory
      • Emotional Regulation
      • Planning
      • Organization
    • Nonetheless, struggle with Fatigue.
    • Nonetheless, struggle with OVER-EXCITABILITIES

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Kaiser Family Foundation (KFF)
Asynchonous/OVER-EXCITABLE people may be/probably using LEGAL and/or ILLEGAL SUBSTANCES to "MANAGE" an unwieldy load.
  • On the legal side--
    • Caffeine
    • Sugar
    • Alcohol
    • Marijuana
    • Tobacco/Cigarettes/Vaping
    • Prescription Drugs
  • On the Illegal side ---
    • Misuse of Prescription Drugs
    • Opioids
    • Cocaine
    • Methamphetamine
    • Etc.
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For the Neuro-Diverse Asynchronous Person who is more vulnerable to Psychiatric Disorders ---I would submit the reason they are more vulnerable is because their needs for "HOMEOSTASIS" don't "MATCH" with the MODERN LIFESTYLE.

AND THERE ARE "NO EXCUSES"

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"SUPPORTED EMPLOYMENT" is often a component of DOJ (US Department of Justice) Olmstead Settlement Agreements --- it's often a good deal for TAXPAYERS as well in the long run.

That "SUPPORTED EMPLOYMENT" needs to include viable options for the asynchronous person who is often struggling to manage:
  • BIG STRENGTHS
  • EXECUTIVE FUNCTIONING CHALLENGES, and
  • FATIGUE
The way we avoid BURNOUT and BREAK-DOWN is not by doing nothing ----It's by:
  • Building on Strengths
  • Compensating for Executive Functioning Issues, and
  • Individualizing "TIME MANAGEMENT" ---
    • especially, for those "SLOW PROCESSORS" who sometimes to often are dealing with a much HEAVIER SENSORY/INFORMATION LOAD.

Individual Olmstead Complaints

9/27/2022

 
People With Cognitive Disabilities who are Institutionalized or Homeless*

*Also At Risk of Institutionalization

Often when we think of Olmstead we think of the BIG CLASS ACTION.
  • There have been those.
  • AND they have not only achieved important gains in those states but they have also set important precedents.
 
  • BUT the LARGE OLMSTEAD CLASS ACTION presents numerous challenges ---- LOGISTICALLY and FINANCIALLY.
    • That's why we haven't seen more of them.
    • Not because the STATES are all in COMPLIANCE.
 
  • There are broad REMEDIES in the context of Cognitive Disability.
 
At Orchid, I'm going to be focusing on initially:
  • SUPPORTIVE HOUSING, MENTAL HEALTH RESIDENTIAL, FAIR HOUSING ASSISTED LIVING & NURSING HOME PLACEMENTS as desired by the client.
    • including Assertive Community Treatment (ACT)

From my perspective, it doesn't have to be ACT but it has to be ADEQUATE and SUFFICIENT.
  • It is not ultimately my choice --- BUT I'm not going to advise something I don't think is ADEQUATE.
    • Having said that, I have been in situations in which the client is the one advising me that they want a Nursing Home placement where I've been pushing SUPPORTIVE HOUSING.
  • Further, if issues do come up down the road --- we're going to be looking to COLLABORATIVELY (if possible) address those with providers, the State, whoever.
  • including HOUSING
    • EVERYBODY knows HOUSING is a HUGE ISSUE and it's a HUGE ISSUE In COLORADO,
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Cook County Sheriff Dart
The STREET is a very dangerous place for someone with a COGNITIVE DISABILITY.
  • Sheriff Dart in Chicago is famous for saying on 60 Minutes --- now probably 9 years ago ---
    • We've got a society that finds it objectionable to warehouse people in a Mental Institute --- but you're fine with a jail --- "YOU'VE GOT TO BE KIDDING ME."
    • The same can be said for HOMELESSNESS.
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MOTEL VOUCHERS and INTERIM MEASURES
  • I think it is the STATE'S RESPONSIBILITY to make up the DIFFERENCE to meet the NEED for MOTEL VOUCHERS
    • for that segment of the HOMELESS POPULATION that is a PERSON with a DISABILITY and at risk of institutionalization.
      • That is probably a big segment of the chronically homeless population.
  • NOW, if the STATE can get others --- the FEDS, the MUNICIPALITIES, the COUNTIES, PHILANTHROPIC EFFORTS to fill in the gap ---
    • THAT'S GREAT
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Voltaire
FURTHER:  We are going to be taking a HARM REDUCTION APPROACH.

We don't want the "PERFECT" to be the enemy of the "GOOD" or "MUCH BETTER."
  • Now the "MUCH BETTER" needs to be determined by the CLIENT --- BUT there are a lot of people (not everybody) who would definitely choose MORE INTEGRATION as opposed to wait another 20 years for PERFECT INTEGRATION.
OLMSTEAD doesn't work well as an EVENT --- it's an ON-GOING PROCESS --- and we do need ON-GOING PLANNING and:
  • MEASURABLE GOALS
  • REASONABLE TIME FRAMES, and
  • FUNDING to SUPPORT an EVOLVING PLAN.

The need for Intensive treatments, Olmstead & MISMATCHED FINANCIAL INCENTIVES

9/23/2022

 
SEEMINGLY MISMATCHED FINANCIAL INCENTIVES

Some of the "unspoken logic" behind Olmstead and Mental Health Community Services was that:
  • Intensive Community Services would be so much LESS EXPENSIVE than large MENTAL HEALTH INSTITUTIONS.
  • The problem was that we severely limited our BED SPACE and didn't adequately INCREASE ACCESS to those INTENSIVE COMMUNITY SERVICES ---
    • those INTENSIVE SERVICES may be less expensive than the HOSPITAL, BUT
    • those INTENSIVE MENTAL HEALTH SERVICES aren't  CHEAP either.
So in Colorado and most States ---
  • There isn't adequate BED SPACE, AND
  • There isn't adequate access to INTENSIVE COMMUNITY TREATMENT such as ASSERTIVE COMMUNITY TREATMENT
    • MEANING those TREATMENTS/ SERVICES are not AVAILABLE where "REASONABLY MEDICALLY NECESSARY."
    • There is generally an ARTIFICIAL LIMIT not based on NEED.
The SERVICE PROVIDERS and INSTITUTIONS who are really taking the FINANCIAL HIT are LAW ENFORCEMENT & JAILS --
  • Generally, NOT funded by the STATE but by MUNICIPALITIES & COUNTIES.
  • This has turned into a POLITICAL FIASCO and a NIGHTMARE for People with Serious Cognitive Disabilities and their Families.
 
Yeah, we're STARTING to address this ---
  • BUT Mental Health Providers riding-- with COPS is just the TIP OF THE ICEBERG.
 
SCREENING the PRISON POPULATIONS for:
  • BRAIN INJURY
  • Neuro-Developmental Differences/Disorders such as ADHD & Autism
  • PSYCHIATRIC DISORDERS, and
  • SUBTANCE ISSUES (that are often CO-MORBID with one or more of the above)
--- could be an important step in not only understanding but acquiring CRITICAL DATA to address a HUMAN RIGHTS TRAGEDY of MODERN TIMES.
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Colorado State Government in the past has taken a position that is probably a position that many States take:
  • "Hey, Olmstead/the ADA don't require that any PARTICULAR or SPECIFIC TREATMENT be AVAILABLE."
  • With respect to ASSERTIVE COMMUNITY TREATMENT (the GOLD STANDARD in more ways than one for Intensive Community Treatment) ----
    • "We provide that as FUNDS  and our OUTDATED SYSTEMS allow."
 
  • This ATTITUDE is what generally leads to "ASSERTIVE COMMUNITY TREATMENT" being included as a COMPONENT of many if not most US Department of Justice Olmstead Settlement Agreements with States involving people with "MENTAL ILLNESS."
 
What Olmstead is about is preventing the "UNNECESSARY INSTITUTIONALIZATION" of people with disabilities.When we're talking about people with Neuro-Developmental Differences that can make them more vulnerable to various forms of SENSORY OVERLOAD, STRESS & PSYCHIATRIC DISORDERS that impact a wide and idiosyncratic range of EXECUTIVE FUNCTIONING ----

Rain City
Housing First & Assertive Community Treatment
(Acknowledges what many people probably in Canada & the US already know --- HOUSING ALONE is not always going to be enough)

At 6:27:  Canadian Psychiatrist tells it like it is:
  • Complex Needs
  • Flawed Systems, and
  • People who don't get "BETTER"
As the CANADIAN PSYCHIATRIST above so honestly distills:
  • You don't get people "BETTER" with COMPLEX NEEDS if the "SYSTEM THAT IS SUPPORTING YOU ISN'T VERY GOOD." 
  • The SYSTEM is flawed in BC (British Columbia) probably in most of Canada [in Colorado, and in most of the US].
We're often talking about needing a "SYSTEM" that can address a WIDE RANGE of NEEDS.
I would submit the underlying drivers of those WIDE RANGES OF NEEDS are IDIOSYNCRATIC EXECUTIVE FUNCTIONING CHALLENGES that are impacting every area of life.
AND if we do provide that SUPPORT and really LISTEN to the person's GOALS and DEVELOP & EMPLOY their STRENGTHS---Things start to look a lot "BETTER."
In some ways, this is our RESIDENTIAL SCHOOLS for INDIGENOUS PEOPLE ----
  • It is not going to be easy to come to terms with what we've done and what we're currently doing.
  • BUT if we start collecting HONEST DATA and do our best to FUND REASONABLY MEDICALLY NECESSARY Placements, Housing & Intensive Services ---
  • AND COMPLY WITH CURRENT LAW ---
  • That would be a BIG STEP IN THE RIGHT DIRECTION.
A Common Issue in the US with regard to INDIGENOUS PEOPLE and PEOPLE with DISABILITIES ---
  • It's not that the LAWS or TREATIES weren't there --
  • They were just IGNORED when it was INCONVENIENT.
  • That is certainly true for Olmstead and it's true in Colorado.
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